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Pharmacy Competition - Dispensing practices under renewed threat

A recent U-turn on a Scottish pharmacy application sets a worrying precedent, writes Alan Kennedy.

On 12 August, Fife Pharmacy Practices Committee approved the application for a commercial pharmacy in the rural Scottish community of Leuchars.

This unexpected turn of events has left many local patients, politicians and dispensing doctors angry and confused, since an earlier application was turned down. The decision could have far-reaching consequences for other dispensing practices north of the border.

The background to this is that, in early September 2008, an application was received from Levenbrae, a West Scotland-based company, to open a local pharmacy in Leuchars; the area is served, along with the adjacent community of Balmullo, by a dispensing medical practice with purpose-built premises in both locations.

The practice has evolved and developed over the years and now, thanks to substantial reinvestment by the partners, offers a wide range of NHS services. The thought that its viability could be undermined inspired more than 2,000 people to sign a petition and provoked some 150-plus letters of protest.

First application refused
Fortunately, the application was rejected by the pharmacy committee and the subsequent appeal failed for the same reasons: that 'the existing premises were perfectly adequate as demonstrated by the local support for them and the proposed premises were unsuitable.'

However, in June, a second application was made, virtually identical to the first but with a small survey of 100 people attached.

The second application came from the same solicitor's address as the first, on behalf of a company called Fraser, Mcpherson and Partners. This application was considered on 12 August by the pharmacy committee and, this time, it was approved.

Given that the first application and the appeal were rejected, it is difficult to understand why the latest application has been successful. Apart from a somewhat inadequate survey, it is identical to the first.

The approval is consequently a source of bewilderment and anger to patients in both the affected communities. An appeal by the practice is to be made for a second time and, yet again, the community councils will be holding public meetings (in mid-September) to address the situation and learn of the consequences which may follow if the decision is overturned.

Some 2,000 signatures against the new application have already been recorded.

From 1 July 2009, area health boards are required to take all reasonable steps to assess public opinion on such applications. The Fife NHS board did not have to do this because the application was made just before the new rules came into force. However, it failed in its moral obligation to do so. This matter, although raised, was not recognised in the committee's deliberations.

The appeal by the dispensing practice, now ongoing, will address the decision in depth but, in the interim, there are a number of factors that stand out as highly significant, including the flawed nature of the survey; inadequate premises proposed; and the assumption that dispensing must cease in the two existing surgeries. In fact, the Fife NHS board has the necessary powers to permit continuance of surgery dispensing (see box below).

Patient interests ignored
Back in January 2009, the chief executive of NHS Fife said: 'Fife's Pharmacy Practices Committee considers each application for a new pharmaceutical contract on its merits and makes judgments based on the needs and interests of the patients in the neighbourhood.'

If that is the case, it is strange that, yet again, patients' views and interests have been ignored by the unfair and undemocratic process within Scotland's pharmacy regulations. These are the subject of a Scottish Executive review. Dispensing practices will continue to be at risk while the present rules are applied.

In his address to the pharmacy committee on behalf of the applicant, James Semple of the Fraser McPherson Group aptly summed up what is wrong with the present legislation, stating: 'If this application is not granted, it is something that will keep coming back again and again.'

Surely, this not a good enough reason to undermine - or even destroy - existing GP services.

  • Mr Kennedy is a patient at the Leuchars and Balmullo Village Surgeries and initiator of Scottish Parliamentary Petition 1220

Issues to Address in the Second Appeal

  • The committee has reversed its decision on an application identical to the first, even though the former was rejected convincingly initially and again on appeal.
  • The survey results submitted by the applicant were construed to suggest that local people had a better understanding of what a commercial pharmacy could bring. It was carried out in Leuchars alone and therefore we believe it was flawed both in concept and in execution.
  • The approved premises have the same layout as in the first application, with little space for both general dispensing activities and private consultation, no access for disabled users, and no parking areas.
  • The applicant assumes that dispensing must cease in both practices. This is contrary to the fact, recently confirmed by the Scottish Executive, that Fife NHS has the powers necessary to permit continuance of surgery dispensing.
  • The committee was of the view that the application concerned NHS services in Leuchars alone. It seems incredible that it should see it in this light when the effects of any approval may also have very real adverse affects on non-Leuchars patients of the practice.



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